Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG FP ELIZ, Ballad Health Medical Associates, BHMA Family Medicine Elizabethton
Organization subpart
No
Provider details
NPI number
Authorized official
CARL S KILGORE (PRESIDENT)
(423) 302-3051
Entity
Organization
Contact information
Practice address
1497 WEST ELK AVE, SUITE 21, ELIZABETHTON, TN 37643
(423) 542-7420
(423) 542-7425
Mailing address
1497 WEST ELK AVE, SUITE 21, ELIZABETHTON, TN 37643
(423) 542-7420
(423) 542-7425
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020487839
DEPARTMENT OF LABOR
TN
05
—
1255634564
—
VA
05
—
1526580
—
TN
Enumeration date
12/08/2010
Last updated
03/29/2019
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